HomeMy WebLinkAbout03-0188PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
/ t
also known as
Deceased.
Social Security
No.
To:
Register of Wi~s for ~the _
County of (~J.,_~..z/~L~/~v(~in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl/r' fi for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in -~z-~.-/
h 1 5 last family or principal residence at '~--~
(list street, number and municipality)
De~dent..then -~ years~fag% died ~
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) M1 personal property $
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
Petitioner.__
the following spouse (if any) and heirs:
Name
after a proper search ha ascertained that decedent left no will and was survived by
Relationship
A.,')
Residence
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
SS
The petitioner(s) above-named swear(s) or affirm(s) that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this _~_k~_~d __ day of
Estate of ,
, , , Deceased
c
GRANT OF LETTERS OF ADMINISTRATION
AND NOW D~ac_14 ~ ~',~, in consideration of the petition on
the reverse side hereof, satisf~tory proof having been presented before me,
IT IS DECREED that
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to
in the estate of ~ef~g¢.~
I
FEES
Letters of Administration .....
Short Certificates( ) .......... $ ~-~-~
Renunciation ................ $
~ TOTAL __ $_.~_~o
Filed . .~ ~.~ ........... A.D.
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: ,~"'~713~/-'~' ~/
/
Date of Death: F~-~ 0~ ~, / ~ ~ ~
Will No. A-) ~L Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on :
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
917:0[\.i L[ NIt[' ~0. Capacity:__
Signature
Address
Telephone
Personal Representative
Counsel for personal representative
IN THE MATTER OF
ESTATE OF:
JEFFREY A BAILEY
STATE OF PENNSYLVANIA
IN THE ORPHAN'S COURT
OF CUMBERLAND COUNTY
ESTATE#: 21-03-188
DATE OF DEATH: 02J23/03
STATEMENT OF CLAIM
1. The creditor, Chase Cardmember Services, certifies that there is due and owing by JEFFREY A BAILEY, deceased,
the sum of FOUR THOUSAND EIGHT HUNDRED THIRTY THREE DOLLARS AND SEVENTY CENTS ($
4,833.70).
2. The nature of the claim is a MASTER CARD account 5183377620459925.
3. The name and address of the claimant is: Chase Cardmember Services, 3700 Wiseman Blvd., 3rd, FL, San Antonio,
TX 38251.
4. The name and address of the claimant's agent is: Jennifer L. Strehlein, Estate Recoveries, Inc., P. O. Box 24566,
Baltimore, Maryland 21214.
5. This claim is not contingent and is not secured by any liens or judgments. The last payment on the account was made
on 02/18/03 in the amount of $150.00.
6. This claim is not based on any one instrument. Said balance has accrued since the account was established.
On behalf of Chase Cardmember Services, creditor, I do solemnly declare and affirm under the penalties of perjury that
the information in th~foregoing claim is true and correct to the best of my knowledge, information and belief. I have made
diligent inquiry ,-4 ......
and examxnat~on, and I beheve the clmm ~s just and all legal offsets, payments, and credits made known to
the affiant have bee ~n~._llowed.
My Commission Expires:
JENa_- ER I~! sTREHLEIN '
Estate Recoveries, Inc.
P.O. Box 24566
Baltimore, Maryland 21214
(410) 444-8022
Baltimore City, Maryland:
IN WITNESS WHEREOF, I hereunto set my hand and Notarial Seal this August 08, 2003.
October W
%: ..' ~
SHANNON K. HEIM, Notary Public
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT'~IVISION
I I I
File No. 21-03-188
Estate of Jeffrey A Bailey
I I I
, Deceased
NOTICE OF CLAIM by J~',~Nlr~,U L_ ~qTREHI,EIN: AGlZ, NT FOR CttA~qi¢, CARI'}MEMRER ,qlZRVICES
Filed Pursuant to Section 3532 (b) (2) of the Probate, Estate,
and Fiduciary Code, 20 Pa. C.S.A §3532 (b) (2) .
To the Clerk of the Orphans' Court Division:
Enter the claim o
(Claimant)
in the amount of $4,833.70 , against the above entitled
estate. The Decedent, who resided at
Carlisle, PA 17013-95114
(City)
Pennsylvania, died on ~ohrllary 2'1; 2flfl'l
43 Mare Road
(Street Address)
~ C. nmherland
Written notice
County,
· . of said
claim was given to Brenda K,~llailey
(Personal Representative, or
his Counsel)
If-known to claimant, at 43 Mare Raod
Carlisle, PA 17013-9514
(Address)
,on August 08. 2003
(Date)
Claimant's Counsel:
STREHLEIN, AGENT
~NNIF6R L.
Post Office Box 24566~ Baltimor% Maryland 21214
(Address)
(Address)
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHAN'S COURT DIVISON
NO. 21-03-188
ESTATE OF: JEFFREY A BAILEY
deceased.
Notice of Claim by CHASE CARDMEMBER SERVICES
fried pursuant to Section
3532(b) (2) of the
PEF Code.
Jennifer L. Strehlein, Agent
ESTATE RECOVERIES, INC.
P.O. Box 24566
Baltimore, Maryland 21214
(410) 444-8022
BALOGH BECKER~ LTD.
A'FrORNEYS AT LAW
4150 OLSON MEMORIAL HIGHWAY, SUITE 200
MINNEAPOLIS, MINNESOTA 55422
ADDRESS SERVICE REQUESTED
MINNESOTA OFFICE:
JAMES A. BALOGH - MN
GARY W. BECKER- DC, FL, IL, MN, WI*
*CREDITOI~S RIGHTS S~EClALIST
AMERICAN BOARD OF CERTIFICATION
CHELSEA A. JAGUSCH - M N, WI
ANGELA M. HORN - MN
MICHAEL D. JOHNSON - MN
CYRENTHIA D. JORDAN - M N
MARY ELLEN WEEMAN - MN, MO
'[HERSlA O. LEE - MN
EVE C. ZAMORA - MN
REGISTER OF WILLS
BALOGH BECKER, LTD.
ATTORNEYS AT LAW
SEND ALL WRIT[EN REPLIES TO:
4150 OLSON MEMORIAL HIGHWAY, SUITE 200
MINNEAPOLIS, MINNESOTA 55422-4804
TELEPHONE 763-852-8440
FAX 763-852-8499
TOLL-FREE 888-762-9997
CUMBERLAND COUNTY COURTHOUSE
1 COURTHOUSE SQUARE, #102
CARLISLE, PA 17013
In the Estate of
Probate Case No.
Social Security No:
Last known residence:
Our Client:
Account Number:
Amount of Debt:
JEFFREY A BAILEY
21-03-188
188585785
43 MARE RD CARLISLE, PA 17013
DISCOVER FINANCIAL SERVICES, INC.
6011002036522332
$ 508.67
ARIZONA OFFICE:
7702 EAST DOUBLETREE
RANCH ROAD
SUITE 300
SCOTTSDALE, AZ 85258
DIANA THEOS - AZ, CO
OF COUNSEL:
LITOW LAW OFFICES, P.O.
(IOWA)
LUSTIG, GLASB~ & WILSON, P.C.
(MASSACHUSETTS)
07/30/03
Dear Sir or Madam:
Enclosed please find a Creditor's claim to be filed in the record with the above-referenced Estate.
Please remm a file stamped copy of the claim in the enclosed self-addressed, stamped envelope. Thank you for
your assistance. If you have any questions or concems, please call our firm toll free at 1-888-762-9997.
Cordially,
Balogh Becker, Ltd.
Attorneys at Law
Enclosures
A check for $5.00 for the filing fee.
cc: Attorney for Estate
Personal Representative
This letter is an attempt to collect a debt and any information obtained will be used for that purpose. This letter
is from a debt collector.
3240 7/'29/2003 979001
COMMONWEALTH OF PENNSYLVANIA
NO TICE OF CLAIM
COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
In Re: The Estate of:
JEFFREY A BAILEY
Deceased
Court File No: 21-03-188
TO: THE CLERK OF THE ORPHANS' COURT DIVISION:
Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate,
Estates, and Fiduciaries Code, :)0 PA.C.$.A. §3532(b)(2).
DISCOVER FINANCIAL SERVICES, INC.
1) Claimant's name:
C/O BALOGH BECKER LTD, 4150 OLSON MEIV[3RTAL
2) Claimant's address: HWY #200 ~
MINNEAPOLIS, MN 55422
8887629997
3)
4)
Creditor listed below is the owner and holder of a claim in the amoui~ of
$ 508.67
The facts upon which this claim is based:
5)
6)
7)
Decedent's address: 43 MARE RD CARLISLE, PA 17013
Date of Death: 02/23/03
That the claim arose prior to the death of the decedent on or about
8) That the claim is secured by.
On behalf of the claimant, ! do solemnly declare and affirm under the penalties of
perjury that they !nformation and representations made herein are true and correct
to the best of r~y knowledge, information and belief. ~
Dated: ~_~4"~ ~.~ ~
/ v Chelsea A. Jagusch/Angela M. Horn, Attomey
Wri~en nbtice of claim was given to Personal Representative and/or his/her counsel
as stated below:
BRENDA K BAILEY
Name
43 MARE RD
Address
CARLISLE, PA 17013
City/State/Zi p
Date notice/ m~iled
IN RE ESTATE OF: JEFFREY A BAILEY
AFFIDAVIT OF ACCOUNT
The undersigned, being first duly sworn deposes and states the follows:
1. Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit.
Your Affiant has reviewed the account records of the Claimant with respect to the
decedent. Your Affiant is familiar with these records and accounts and reviews them as a
regular part of her duties.
The Decedent purchased merchandise in the amount of $ 508.67
account number 6011002036522332
evidenced by
The unpaid balance does not include any post-death late payment charges, accrued
interest, collection costs or attorney' s fees.
Further your affiant sayeth not
BALOGH BECKER, LTD.
By: 552-
One of its attorneys:
Chelsea A. Jagusch __
Michael D. Johnson
Mary Ellen Weeman __
Eve C. Zamora
Angels M. Horn J
Cyrenthia D. Jordan __
Thersia O. Lee
4150 Olson Memorial Highway, Suite 200
Minneapolis, MN 55422-4804
Subscribed and sworn before me
This _~-'~ //d~fi~f .~~!~,2003.
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 1/10/2005
BAILEY BRENDA K
43 MARE ROAD
CARLISLE, PA 17013
RE: Estate of BAILEY JEFFREY A
File Number: 2003-00188
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in,the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 2/23/2005
Your prompt attention to this matter will be appreciated.
Thank You.
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
Estate of BAILEY JEFFREY A
Late of NASSAU COUNTY NEW YORK
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
Estate No.: 21-03-00188
Date:
3/09/2005
NO.: 21-03-00188
BAILEY BRENDA K
43 MARE ROAD
CARLISLE PA 17013
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 6. 12, SUPREME COURT ORPHANS' COURT RULE
Personal Representative: BAILEY BRENDA K
Personal Representative Counsel: ** NO INFORMATION FOUND **
Date of Decedent's Death: 2/26/1994
Date of Delinquency Notice: 2/23/2005
The undersigned, Glenda Farner Strasbaugh, Clerk of Orhans'
Court, in accordance with rule 6.12, Supreme Court Orphans' Court
Rules, hereby notifies the Orphans' Court Division, Court of Common
Pleas of Cumberland County, that neither the above named personal
representative nor their counsel, have filed with the Register of
Wills or Clerk of Orphans' Court, his/her Status Report required by
Rule 6.12, Supreme Court Orphans' Court Rule, and that the
requisite notice, pursuant to Rule 6.12, Supreme Court Orhans'
Court Rules, was given by the Clerk of Orphans' Court on 2/03/2005
and that the ten (10) day notice to file the status report has
expired. Accordingly, in accordance with Rule 6.12 the Court is
hereby notified of such delinquency and the undersigned requests
that a Court conduct a hearing to determine whether sanctions
should be imposed upon the delinquent personal representative or
their counsel.
cc: File
Personal Representative
Counsel
~~~
Glenda Farner Strasbaugh
Clerk of Orhans' Court
A hearing is scheduled for May 06, 2005 at 9:30 AM in
Courtroom No. ~.3 If the Status Report is filed prior to the
hearing date, the hearing will automatically be cancelled.
J
Geo
02/15/2005 Tlm 13:53 FAX 717 774 8548
!41 003/003
STATUS REPORT U1\TDER RUI-E 6.12
NarnenfDecedent Sc{{(c, A ~; k'1
Date of Death: r:-GbrJi.-<'l 2..3 I 200 ]
Win No.:
2 I - 03- I g~
. 2 I - 0 3 - /9 ~
Admin. No.:
PurSUmlt to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
follo'Wing wiLli respect to completiolJ of the admi.nistration of the above-captioned estate:
1. State whether adl~tration of the estate is complete:
Yes 0 No
2. Ifthe answer is No, state when the personal representative reasonably believes
that the administration will be complete: 3".., (}.... f1..;'"
3. If the answer to No.1 is Yes, state the following:
a, Did the personal representative :file a final account witb. the Court?
Yes .~ No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
actount is:
c, Did the personal representative state an account informally to the parties
in interest? Yes 0 No O.
c. Copie~ of receipts, releases, joinders and approval of formal or
infom'lal accounts may be filed with the Clerk of the Orphans ~ Court
and may be attached to this report.
Date:...23 0';- ~ h
Signature
!flJChhC I A. 5~t,</t/ f 8~.
Name
<.0
Cj
I '1 vJ j'o tin. J t iu-r )15-IC
Address
c.;:)
7 }., 2..'-1 c,. 687)
Telephone No.
Capacity: 0 Person.al Representative
o Counsel for personal representative
cd
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 1/13/2006
BAILEY BRENDA K
43 MARE ROAD
CARLISLE, PA 17013
RE: Estate of BAILEY JEFFREY A
File Number: 2003-00188
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
2/23/2006
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
$~~~
~-"
GLENDA FARNER STP~SBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
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Estate of BAILEY JEFFREY A
Late of LOWER FRANKFORD TOWNSHIP
Estate No.: 21-03-00188
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
Date:
3/14/2006
NO.: 21-03-00188
BAILEY BRENDA K
188 GOODYEAR RD
CARLISLE PA 17013 9407
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 6. 12, SUPREME COURT ORPHANS I COURT RULE
Personal Representative: BAILEY BRENDA K
Personal Representative Counsel: ** NO INFORMATION FOUND **
Date of Decedent's Death: 2/23/2003
Date of Delinquency Notice: 2/23/2006
The undersigned, Glenda Farner Strasbaugh, Clerk of Orphans'
Court, in accordance with rule 6.12, Supreme Court Orphans' Court
Rules, hereby notifies the Orphans' Court Division, Court of Common
Pleas of Cumberland County, that neither the above named personal
representative nor their counsel, have filed with the Register of
Wills or Clerk of Orphans' Court, his/her Status Report required by
Rule 6.12, Supreme Court Orphans' Court Rule, and that the
requisite notice, pursuant to Rule 6.12, Supreme Court Orphans'
Court Rules, was given by the Clerk of Orphans' Court on 1/17/2006
and that the ten (10) day notice to file the status report has
expired. Accordingly, in accordance with Rule 6.12 the Court is
hereby notified of such delinquency and the undersigned requests
that a Court conduct a hearing to determine whether sanctions
should be imposed upon the delinquent personal representative or
their counsel.
cc: File
Personal Representative
Counsel
Gl~r~~
Clerk of Orphans' Court
A hearing is scheduled for May 01, 2006
Courtroom No.2. If the Status Report is
hearing date, the hearing will automatic
at 11:00 AM in
d prior to the
be:u~~
Edgar B. Bayley PJ '
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15056051058
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Vear
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
21 03
188
Date of Birth
188-58-5785
02/23/2003
06/29/1964
Decedent's Last Name
Suffix
Decedent's First Name
MI
Bailey
Jeffrey
A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Bailey
Brenda
K
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
. 1. Original Return
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
2. Supplemental Return 3. Remainder Return (date of death
prior to 12-13-82)
4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required
death after 12-12-82)
7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
4. Limited Estate
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTE() T~:
Name Daytime Telephone Number
Michael A. Scherer, Esq
Firm Name (If Applicable)
(717) 249-6873
REGISTER OF WILLS USE ONl"... I
;
)
O'Brien Baric & Scherer
First line of address
;'~-.)
19 West South Street
-'.
r"0
Second line of address
City or Post Office
State
ZIP Code
DATE FILED
Carlisle
PA
17013
Correspondent's e-mail address:mscherer@obslaw.com
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements. and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which pre parer has any knowledge.
DATE
05/15/06
:IG_:~TUR_~~ZSPON~FOR. G fi';
ADDRE
oodyear Road, Carlisle, PA
SIGNATURE O~ THAN REPRESENTATIVE
ADDRESS . ~,..,+t.. S+ CAr I.-.s ,~ t>A
J 4 W .. PLEASE USE ORIGINAL FORM ONLY
17013
Side 1
15056051058
~
L
15056051058
~.
( r~t
--..J
15056052059
REV-1500 EX
Decedent's Name:
Jeffrey
A Bailey
RECAPITULATION
1. Real estate (Schedule A).
2. Stocks and Bonds (Schedule B) .
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . . .
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6 Jointly Owned Property (Schedule F) Separate Billing Requested . . . .
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested. . . .
8. Total Gross Assets (total Lines 1-7).
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . 10.
11 Total Deductions (total Lines 9 & 10). 11
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . 13.
. . . . 14.
14. Net Value Subject to Tax (Line 12 minus Line 13) .. . . . . .
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X.O 45 ( 238.42 )
16. Amount of Line 14 taxable
at lineal rate X.O_
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
16.
17.
18.
19. TAX DUE.
..........19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059
Side 2
L
Decedent's Social Security Number
188-58-5785
1.
0.00
2.
0.00
0.00
4.
0.00
21,474.80
6.
0.00
7.
0.00
8
21,474.80
2,640.00
19,073.22
21,713.22
( 238.42)
( 238.42)
0.00
0.00
15056052059
--.J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Jeffrey A Bailey
f---- -
STREET ADDRESS
43 Mare Road
File Number
21
03 188
DECEDENT'S SOCIAL SECURITY NUMBER
188-58-5785
--
CITY
Carlisle
I STATE
PA
I. ZIP
17013
_ _ n
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
0.00
Total Credits (A + B + C ) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... D [iJ
b. retain the right to designate who shall use the property transferred or its income; ............................................ D [iJ
c. retain a reversionary interest; or.....,..,....,....",........,....,..".......,..,..........,..........."....................,.........,....,............ D [i]
d. receive the promise for life of either payments, benefits or care? .................................................................... D [i]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D [iJ
3, Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ...........". D [iJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ......................................................................................................................,. D [iJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. 99116 (a) (1.1) (ii)], The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S, 99116(a)(1 ,2)],
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH/ BANK DEPOSITS/ & MISC.
PERSONAL PROPERTY
ESTATE OF
Jeffrey A. Bailey
FILE NUMBER
21-03-188
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1. Allfirst Checking Account, Accl. # 00102-5750-0
2,350.40
2. 1998 Ford F150 Lariat
19.12440
TOTAL (Also enter on line 5, Recapitulation) $
21,47480
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Jeffrey A. Bailey
FILE NUMBER
21-03-188
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Forethought Funeral Planning
1,890.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2.
Attorney Fees
750.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $
2,640.00
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-03)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jeffrey A Bailey
FILE NUMBER
21-03-188
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. American Home Bank, automobile loan, loan # 602302
VALUE AT DATE
OF DEATH
19,073.22
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same SIZe)
19,073.22
/
iii allfirst
JEFFREY A BAILEY
43 MARE RD
CAR~ISLE PA 17013-9514
1,"11111I11111I".11..11.1.111I1.1111111.1"1.1111..1111.1.11
Page 1 of 3
Basic ~hecking
Jeffrey A Bailey
Acct No 00102-5750-0
March 6, 2003 thru April 3, 2003
o allflrst.com 0 24-hour
CUstomer Service
1-800-533-4630
Activity Summary
Number of checks safekept
o Balance on 03/05
Other activity
Balance on 04/03
$2,350.115
-2,350.115
.00
Other activity
Date Description
Amount
03/12 CLOSING WITHDRAWAL
-2,350.115
C2'35O.115~
End of Day Ledger Balance
Account balances are updated in the section below on days when transactions posted
to this account.
Date
Balance
03/05
G3/U
$2,350.115
.CiO
Allfirst, a division of Manufacturers and Traders Trust Company
000389
0001-98317426865 050
ronGH);;"
T~, "A" ":'OU w,e'
f U " ror thos
"t easler J'
Make 1
"
REAL ESTATE LOAN
ANNUAL STATEMENT
'EAR CUSTOMER
TIUS IS YOUR YEAR-END ANNUAL STATEMENT.
PLEASE REVIEW IT CAREFULLY AND CALL US
SHOULD YOU HAVE ANY QUESTIONS. PLEASE
NOTE THE TOTAL ANNUAL INTEREST PAID.
LOAN ACCOUNT
LOAN BALANCE
PAYMENT AMOUNT
INTEREST RATE
JEFFREY A BAILEY
BRENDA K BAILEY
43 MARE RD
CARLISLE PA 17013-9514
'OLLATERAL - 43 MARE RD CARLISLE PA 17013
.l:'Ali~ l
12/31/03
STATEMENT DATE
000000602302
.00
234.71
7.24000
********************************************************************************
MONETARY TRANSACTIONS
FFECTIVE POSTING TRAN TRANSACTION *********** POSTING ***********
DATE DATE CODE AMOUNT DESCRIPTION AMOUNT
1/06/03 01/06/03 TC11 234.71 SCHEDULED PAYMENT - AUTO SPLIT
PRINCIPAL 130.43
INTEREST 104.28
LOAN BALANCE 19,341. 51
1/06/03 01/06/03 TC13 65.29 GENERATED EXCESS PRIN PAYMENT
LOAN BALANCE 19,276.22
2/19/03 02/19/03 TC11 234.71 SCHEDULED PAYMENT - AUTO SPLIT
PRINCIPAL 66.4 7
INTEREST 168.24
LOAN BALANCE 19,209.75
2/19/03 02/19/03 TC13 65.29 GENERATED EXCESS PRIN PAYMENT
LOAN BALANCE 19,144.46
3/12/03 03/12/03 TC11 234.71 SCHEDULED PAYMENT - AUTO SPLIT
PRINCIPAL 154.96
INTEREST 79.75
LOAN BALANCE 18,989.50
3/12/03 03/12/03 TC13 15.29 GENERATED EXCESS PRIN PAYMENT
LOAN BALANCE 18,974.21
3/31/03 03/31/03 TC42 19,045.72 PAYOFF .
PRINCIPAL 18,974.21
INTEREST 71. 51
LOAN BALANCE 0.00
3/31/03 03/31/03 TC42 0.00 GENERATED PAYOFF
LOAN BALANCE 0.00
*~
r~~
AMERICAN
HOMEB~
CoO 2.302. PJ:~ot c()tS on 03\31 )03 e\\QQ.'h 2-3)
I!J) /g/ aLl $.'-) Z \?,;nc~po..Ocr 7.n-\.cr-es.+-
-\ 2/, 50 .sO-:\<'S.~Qc\\or- S'ee "0 eu{'(\. 'gQ ,\0. (\&
Q~~ O/3.~9 eem c~^~
1>>1S IS 'You Re 1P1' .
_ _G"OUO$lT AT" TEU.WWIIIlCIN,ALW"'I'S c.TMOHOfFlClAL~T ,- Oopooils....y not... ...1iI6bM for lr'onIo<C&"vd.."'....1
Q\ockl and..... _ ....ocoIvO<l ~~ ~~~~::::~ _ .yml>c:I """..cion __ and _, ot cIopOIlI "'. _n ..-..
... Unit.... ComrMlclal CocIo Of any .......- -- ..
~26/03 14:27
Via: MULTIPLE
ADP/AUTOSOURCE INSTANT VALUATION
Request Number: 10200452 ADP
Page 1
Version: 1
ADMINISTRATIVE DATA
Steven Jones
Allstate Insurance Company
Harrisburg Branch
6345 Flank Drive Ste 1000
Harrisburg PA 17112
Claimant:
Insured: BAILEY, JEFFREY A
Claim: 1554569416D01
Loss Date: 02/21/03
Loss Type: COLLISION
Policy: 028500103
Other:
VINSOURCE ANALYSIS
VIN: IFTZX18W2WNB77789
Decodes as:
Accuracy:
History:
1998 Ford F-150 Lariat 4WD Long Bed Ext Cab
DECODES CORRECTLY
NO ACTIVITY WAS REPORTED
NICB REPORT
NICB ACTIVITY:
(NONE)
VALUATION SUMMARY
98 FORD F-150 LARIAT 4WD LONG BED EXT CAB
Typical Vehicle Loss Vehicle Adjustments
Price
Engine
Transmission
Odometer
$16,710
8cyl Gasoline 5.4
4 Speed Automatic
80,832 Mi (typical)
8cyl Gasoline 4.6
4 Speed Automatic
54,537 Mi (actual)
$16,710
-225
1,185
Equipment/Package Adjustment (See Valuation Detail)
70
ADP/AUTOSOURCE Value Before Condition Adjustments
$17,740
Total Condition Adjustments (See Condition Adjustment Detail)
275
------------
------------
Total Condition Adjusted Market Value
$18,015
Applicable Tax:
b %
t Od'V. y"
SALES fAX DOES NOT
APPLY IF THIS VEHICLE
IS A LEASE.
DMW Fee: ~ e 31/
Gross ACV: &(q, /Z{, r-P'
Deductible:- ~~
C k i'IY/c f{jJ-r- 0;r.?;:;v
{I { I ~ fo (tv... c Ie
FAMILY SETTLEMENT AND FINAL RELEASE
IN
THE ESTATE OF JEFFREY A. BAILEY
., .)
,
~.:--1
KNOW ALL MEN BY THESE PRESENTS, that:
WHEREAS, Jeffrey A. Bailey, late of Cumberland County, Pennsylvania, 'died
intestate on March 23, 2003; and,
WHEREAS, Letters Of Administration on the estate of the said decedent were truly
issued by the Register of Wills of Cumberland County, Pennsylvania to Brenda K. Bailey
on March 3, 2003; and,
WHEREAS, the Administrator has gathered the assets of the estate of the said
decedent and the assets consist of a bank account and a motor vehicle, to a total value
of $21 ,614.21, as set forth in "Exhibit A," which is a copy of the Pennsylvania Inheritance
Tax Return in this estate; and,
WHEREAS, the debts and deductions of principal, including the payment of
Pennsylvania Inheritance Tax in the said estate, have been made leaving no balance for
distribution from the estate;
NOW, THEREFORE, KNOW, I do hereby stipulate that in order to avoid the
expense and time involved in the filing of a formal account and schedule of distribution, I
have agreed that no account is necessary.
THEREFORE, I do hereby remise, release, quitclaim and forever discharge the said
personal representative, heirs, executors, and administrators and assigns of and from the
said estate and from all actions, suits, payments, accounts, reckonings, claims and
demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing
whatsoever, touching upon the estate of the said decedent, and do further hereby
U)
covenant and agree that should any liability come due to the estate of the said decedent
after the signing of this agreement, I do hereby covenant and agree with each other and
the aforesaid personal representative, that I will contribute pro-rata, our share of the estate
to satisfy any and all claims, demands, suits, or causes of action which may be
successfully prosecuted against the said estate or the aforesaid personal representative
after the signing, sealing and delivery of this family settlement agreement and final release.
IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year
below written opposite my name.
(SEAL)
STATE OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
On this, the l~day of ~ ' 2006, before me, a Notary Public, the
undersigned officer, personally appeared Brenda K. Bailey (known to me or satisfactory
proven) to be the person whose name is subscribed to the within instrument, and
acknowledged that she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
COMMONWEALTH OF f~Ei\ii\lSYLVi\i":/-\
Notarial Seal . 1
Jennifer S. Lindsay, Notary Public
Carlisle Bora, Cumberland County
My Commission Expires Nov. 29, 2007
Member, Pennsyl'j,?ri3 Assoc\ation Of Notaries
ASSETS:
1.
2.
DEBTS:
1.
2.
3.
"EXHIBIT A"
STATEMENT OF ACCOUNT
Allfirst checking account
1998 Ford F-150 Lariat
Forethought Funeral Planning
Estate Administration
American Home Bank auto loan
BALANCE FOR DISTRIBUTION
$ 2,350.40
$19,124.40
$21,474.80
$ 1,890.00
$ 750.00
$19.073.22
$21,713.22
$0.00
....J
15056051058
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
INHERITANCE TAX RETURN
RESIDENT DECEDENT
File Number
21
03
188
Date of Birth
188-58-5785
02/23/2003
06/29/1964
Decedent's Last Name
Suffix
Decedent's First Name
MI
Bailey
Jeffrey
A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Bailey
Brenda
K
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
(e 1. Original Return
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Day1ime Telephone Number
4. Limited Estate
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
o
8. Total Number of Safe Deposit Boxes
Michael A. Scherer, Esq
(717) 249-6873
Firm Name (If Applicable)
REGISTER OF WILLS USE ONLY
O'Brien Baric & Scherer
First line of address
19 West South Street
Second line of address
City or Post Office
State
ZIP Code
DATE FILED
Carlisle
PA
17013
Correspondent's e-mail address:mscherer@obslaw.com
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief.
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
DATE 05/ 1 5/06
ADDRESS
188 Goodyear Road, Carlisle, PA 17013
SIGNATURE o~ THAN REPRESENTATIVE
ADDRESS . ~t.. Sf CAr 1'51.(. t>A
ri W ~ PLEASE USE ORIGINAL FORM O
L
15056051058
15056051058
~
---I
15056052059
REV-1500 EX
Decedent's Name:
Jeffrey
A Bailey
RECAPITULATION
1. Real estate (Schedule A). .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2 Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) Separate Billing Requested. . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:;; Separate Billing Requested. . . . . . .. 1.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9.
10. Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I). . . . . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10)... ... ... .. ...... ......... ... .. . .. . 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ..... . . . . . . . . . . . . . . . . . . . 14.
TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES
15 Arnount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0 45 ( 238.42) 15.
16. Arnount of Line 14 taxable
at lineal rate X.O _ 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Arnount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059
Side 2
L
Decedent's Social Security Number
188-58-5785
0.00
0.00
0.00
0.00
21,474.80
0.00
0.00
21,474.80
2,640.00
19,073.22
21,713.22
( 238.42)
( 238.42)
0.00
0.00
15056052059
-.-J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
188
DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER
Jeffrey A Bailey 188-58-5785
STREET ADDRESS
43 Mare Road
--
CITY I STATE I ZIP -- ~-~--
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
0.00
Total Credits ( A + B + C ) (2)
0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( 0 + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
0.00
A. Enter the interest on the tax due.
0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... 0 [K]
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [K]
c. retain a reversionary interest; or.......................................................................................................................... 0 [i]
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [iJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 [iJ
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [K]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 [K]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jeffrey A. Bailey
FILE NUMBER
21-03-188
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1. Allfirst Checking Account, Accl. # 00102-5750-0
2,350.40
2. 1998 Ford F150 Lariat
19.124.40
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
21,474.80
REV-1511 EX+ (12'99)*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Jeffrey A. Bailey
FILE NUMBER
21-03-188
Debts 01 decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Forethought Funeral Planning
1,890.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2.
Attorney Fees
750.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
,Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2,640.00
REV-1512 EX+ (12-03)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jeffrey A. Bailey
FILE NUMBER
21-03-188
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
American Home Bank, automobile loan, loan # 602302
19,073.22
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
19,073.22
,I
iii allftrst
JEFFREY A BAILEY
43 MARE RD
CAR~ISLE PA 17013-9514
1111111/1111I,11I1111.. II. 1.111I1.1" 1111. I "I. I "I" II" ,1.11
Page 1 of 3
~~sic.. Gpecking
Jeffrey A Bailey
Acct No 00102-5750-0
March 6, 2003 thru April 3, 2003
Q allfirst.com 0 24-hour
CUstomer Service
1-800-533-4630
Activity Summary
Number of checks safekept
o Balance on 03/05
Other activity
Balance on 04103
$2,350.115
-2,350.115
.00
other activity
Date Description
Amount
03/12 CLOSING WITHDRAWAL
-2,350.115
(2,35O.115~
End of Day Ledger Balance
Account balances are updated in the section below on days when transactions posted
to this account.
Date
Balance
03/05
OJ/1 ~
$2,350.115
.00
Allfirst. a division of Manufacturers and Traders Trust Company
000389
0001-98317426865 050
FE2REGH1"
1~~L!\NN\N:U love@
\J N E R" those y
f . r for
"t easle
Make l
03
-3 /3;J~6
..
.l:'AGt.; l
REAL ESTATE LOAN
ANNUAL STATEMENT
12/31/03
STATEMENT DATE
EAR CUSTOMER
THIS IS YOUR YEAR-END ANNUAL STATEMENT.
PLEASE REVIEW IT CAREFULLY AND CALL US
SHOULD YOU HAVE ANY QUESTIONS. PLEASE
NOTE THE TOTAL ANNUAL INTEREST PAID.
JEFFREY A BAILEY
BRENDA K BAILEY
43 MARE RD
CARLISLE PA 17013-9514
LOAN ACCOUNT
LOAN BALANCE
PAYMENT AMOUNT
INTEREST RATE
000000602302
.00
234.71
7.24000
OLLATERAL - 43 MARE RD CARLISLE PA 17013
********************************************************************************
MONETARY TRANSACTIONS
FFECTIVE POSTING TRAN TRANSACTION *********** POSTING ***********
DATE DATE CODE AMOUNT DESCRIPTION AMOUNT
1/06/03 01/06/03 TC11 234.71 SCHEDULED PAYMENT - AUTO SPLIT
PRINCIPAL 130.43
INTEREST 104.28
LOAN BALANCE 19,341. 51
1/06/03 01/06/03 TC13 65.29 GENERATED EXCESS PRIN PAYMENT
LOAN BALANCE 19,276.22
2/19/03 02/19/03 TC11 234.71 SCHEDULED PAYMENT - AUTO SPLIT
PRINCIPAL 66.47
INTEREST 168.24
LOAN BALANCE 19,209.75
2/19/03 02/19/03 TC13 65.29 GENERATED EXCESS PRIN PAYMENT
LOAN BALANCE 19,144.46
3/12/03 03/12/03 TC11 234.71 SCHEDULED PAYMENT - AUTO SPLIT
PRINCIPAL 154.96
INTEREST 79.75
LOAN BALANCE 18,989.50
3/12/03 03/12/03 TC13 15.29 GENERATED EXCESS PRIN PAYMENT
3/31/03 03/31/03 LOAN B~CE 18,974.21
TC42 19,045.72 PAYOFF
PRINCIPAL 18,974.21
INTEREST 71. 51
LOAN BALANCE 0.00
3/31/03 03/31/03 TC42 0.00 GENERATED PAYOFF
LOAN BALANCE 0.00
*-1
r~~
AMERICAN
HOMEB~
CoOZ302.p)Xo:. ~ Of) 03)31)03 C:~Q.YS L3)
-1> I g lOLl :5, / 2 ~t;nc~po..O It 7 n~r-<?~-r
-+ 2 ") , 50 .so.. \-: s..{:o.. c:~~ 00 ..c ee ~ C...l.A"'- '90 c-\o.. (\&
~~"6S3~9 e-eiOl C~f\~
WHUl_Cl"OEPOSlT "T" TEl.L(RSWlNOOII.Al.W"'I'S<:aTAIINlQf~AECfII'T .'
CMdc. and 0"" IIonIo OI' rooelvod lor dopoolt ouIlIOCIIo ... plOYlIIona 01
... UniI.... c-cloI eo......r oppU...... coIIK1IoA aar_l
Oopoolto /IlIr not be .vollolllo lor ifMIco<Ialo vd..",..,oI
8Ani< .)'mbd ......cton __ and.......... doposllOl. _n 'M'.
~26/03 14:27
via: MULTIPLE
ADP/AUTOSOURCE INSTANT VALUATION
Request Number: 10200452 ADP
Page 1
Version: 1
ADMINISTRATIVE DATA
Steven Jones
Allstate Insurance Company
Harrisburg Branch
6345 Flank Drive Ste 1000
Harrisburg PA 17112
Claimant:
Insured: BAILEY, JEFFREY A
Claim: 1554569416D01
Loss Date: 02/21/03
Loss Type: COLLISION
Policy: 028500103
Other:
VINSOURCE ANALYSIS
VIN: 1FTZX18W2WNB77789
Decodes as:
Accuracy:
History:
1998 Ford F-150 Lariat 4WD Long Bed Ext Cab
DECODES CORRECTLY
NO ACTIVITY WAS REPORTED
NICB REPORT
NICB ACTIVITY:
(NONE)
VALUATION SUMMARY
98 FORD F-150 LARIAT 4WD LONG BED EXT CAB
Typical Vehicle Loss Vehicle Adjustments
Price
Engine
Transmission
Odometer
$16,710
8cyl Gasoline 5.4
4 Speed Automatic
80,832 Mi (typical)
8cyl Gasoline 4.6
4 Speed Automatic
54,537 Mi (actual)
$16,710
-225
1,185
Equipment/Package Adjustment (See Valuation Detail)
70
ADP/AUTOSOURCE Value Before Condition Adjustments
$17,740
Total Condition Adjustments (See Condition Adjustment Detail)
275
------------
------------
Total Condition Adjusted Market Value
$18,015
Applicable Tax:
~ %
tOdV.r~
SALES fAX DOES NOT
APPLY IF THIS VEHICLE
IS A LEASE.
DMW Fee: r: e 37)
Gross ACV: &(q, (Zcf, r:-P'
Deductible:- ~~
C It ~k +(0" 0'?,;;::r~
A {I ~ {t,( +V/Aclc
STATIJS REPORT UNDER RULE 6.12
Nam.e of Decedent:
JEFFREY A. BAILEY
Date of Dea.th:
FEBRUARY 23, 2003
Will No.:
21-03-188
Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' COUi~ Rules, I report the
following with respect to completion of the administration of tl1e above-captioned estate:
1. State whether administration of the estate is complete:
Yes ~ No 0
2. lfthe answer is No, state when the personal representative reasonably believes
tl1a.t the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No 2S
b. The separate Orphans' Cou..'i: No. (ifauy) for the personal representative's
account is:
c. Did the personal representative state an account infonnally to the pfu-ties
in interest? Yes J.K] No 0
c. Copies of receipts, releases, joinders and approval of fomla1 or
informal accounts may be filed with the Clerk of the Orphans' Court
'> ' and may be attached to this repo~ , / , '
. Date: ~ '-t J b.l!.JAJ\1). 1\ tv
Signature v
MICHAEL A. SCHERER, ESQUIRE
Name
19 WEST SOUTH STREET
Address CARLI SLE, PAl 7013
(717) 249-6873
Telephone No.
Capacity: 0 Personal Representative
~ C01.l.,TJsel for personal representative
......
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
pr.:-rr'.'''n~n ()cCJ('F (~TICE OF INHERITANCE TAX
":,\;:;, ~H.':;':-," '~~~~M,\ " ;r" $,EHENT I ALLOWANCE OR DISALLOWANCE
h~.!..Jj::;! U~ '"j Oif Ql;DucTIONS AND ASSESSMENT OF TAX
07-17-2006
BAILEY
02-23-2003
21 03-0188
CUMBERLAND
101
APPEAL DATE: 09-15-2006
( See reverse side under Objections)
Amount R-.ittedl I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEI PA 17013
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +-
iiv:is47-ix-AFP-ioi:oSl-NOTici-OF-iNHiiiTANCi-TAX-APPiAiiiHiNT:-ALLOWANCi-oi---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
JEFFREY A FILE NO. 21 03-0188 ACN 101
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
2006 JUL 24 AM II: 36
CI r-f":' f (-,C
L.t,y\ )1
OR'", ,,: ',i. '. 1"-' r-,(~," ',",{T
Ir'j-!,':':;,.",,: ,~) ~'~"\ ):yif'" I
MICHAEL A SCHERERJ!\ESQ ,
OBRIEN ETAL
19 W SOUTH ST
CARLISLE
PA 17013
ESTATE OF BAILEY
DATE
ESTATE OF
DA TE OF DEATH
FILE NUMBER
COUNTY
ACN
.
REV-1547 EX AFP (06-05)
JEFFREY
A
DATE 07-17-2006
NOTE: I~ an asses~ent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
r~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. AIIount of Line 14 at Spousal rete (15) .00 X 00 = .00
16. Allount of Line 14 taxable at Lineal/C1ess A rate (16) .00 X 045 = .00
17. AlIOunt of Line 14 at Sibling rate (17) .00 X 12 = .00
18. Allount of Line 14 texllble et Colleteral/Cbss B rete (18) . 00 X 15 = . 00
19. Principel Tex Due (19)= .00
TAX RETURN WAS: (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..1 Est.t. (Schedul. A)
2. Stocks end Bonds (Schedu1. B)
3. Clos.1y Held Stock/P.rtnership Int.rest (Schedul. C)
4. Mort......s/Not.s Rec.1vllbl. (Schedul. D)
5. Cash/Bank Deposits/Hisc. P.rsonal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transf.rs (Schedul. G)
8. Totel Ass.ts
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expens.s/A~. Costs/Hisc. Expenses (Schedule H)
10. Dabts/Hortgege Lillbiliti.s/Liens (Schedul. I)
11. Tote1 Deductions
12. N.t V.lue of Tex R.turn
13. Ch.ritllble/Govern.ental Bequests; Non-.lected 9113 Trusts
14. Net V.lue of Estat. Subj.ct to Tex
DATE
NUtlBER
INTEREST/PEN PAID (-)
· IF PAID AFTER DATE INDICATED I SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( ) CHANGED
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
21.474.80
.00
.00
(8)
NOTE: To insure proper
credit to your accountl
subsi t the upper portion
of this fore with your
tex peYll8nt.
211474.80
?1.713; ??
238.42-
.00
238.42-
.00
.00
.00
.00
~
~
(9)
(10)
21640.00
( IF TOTAL DUE IS LESS THAN $11 NO PAYHENT IS REIlUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT"" (CR) I YOU flAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
-
19.073
22
(11)
(12)
1I3)
1I4)
(Schedu1. J)
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE